Increasing social inequalities in health in the United States and elsewhere, coupled with growing inequalities in income and wealth, have refocused attention on social class as a key determinant of population health. Routine analysis using conceptually coherent and consistent measures of socioeconomic position in US public health research and surveillance, however, remains rare. This review discusses concepts and methodologies concerning, and guidelines for measuring, social class and other aspects of socioeconomic position (e.g. income, poverty, deprivation, wealth, education). These data should be collected at the individual, household, and neighborhood level, to characterize both childhood and adult socioeconomic position; fluctuations in economic resources during these time periods also merit consideration. Guidelines for linking census-based socioeconomic measures and health data are presented, as are recommendations for analyses involving social class, race/ethnicity, and gender. Suggestions for research on socioeconomic measures are provided, to aid monitoring steps toward social equity in health.

Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines

PURPOSE—Interest in the effects of neighbourhood or local area social characteristics on health has increased in recent years, but to date the existing evidence has not been systematically reviewed. Multilevel or contextual analyses of social factors and health represent a possible reconciliation between two divergent epidemiological paradigms—individual risk factor epidemiology and an ecological approach.
DATA SOURCES—Keyword searching of Index Medicus (Medline) and additional references from retrieved articles.
STUDY SELECTION—All original studies of the effect of local area social characteristics on individual health outcomes, adjusted for individual socioeconomic status, published in English before 1 June 1998 and focused on populations in developed countries.
DATA SYNTHESIS—The methodological challenges posed by the design and interpretation of multilevel studies of local area effects are discussed and results summarised with reference to type of health outcome. All but two of the 25 reviewed studies reported a statistically significant association between at least one measure of social environment and a health outcome (contextual effect), after adjusting for individual level socioeconomic status (compositional effect). Contextual effects were generally modest and much smaller than compositional effects.
CONCLUSIONS—The evidence for modest neighbourhood effects on health is fairly consistent despite heterogeneity of study designs, substitution of local area measures for neighbourhood measures and probable measurement error. By drawing public health attention to the health risks associated with the social structure and ecology of neighbourhoods, innovative approaches to community level interventions may ensue.


Keywords: socioeconomic status; local area; contextual analysis; hierarchical analysis

https://jech.bmj.com/content/jech/55/2/111.full.pdf

Multilevel Analyses of Neighbourhood Socioeconomic Context and Health Outcomes: a Critical Review

Assimilation theory has been subject to intensive critique for decades. Yet no other framework has provided the social science community with as deep a corpus of cumulative findings concerning the incorporation of immigrants and their descendants. We argue that assimilation theory has not lost its utility for the study of contemporary immigration to the United States. In making our case, we review critically the canonical account of assimilation provided by Milton Gordon and others ; we refer to Shibutani and Kwan's theory of ethnic stratification to suggest some directions to take in reformulating assimilation theory. We also examine some of the arguments frequently made to distinguish between the earlier mass immigration of Europeans and the immigration of the contemporary era and find them to be inconclusive. Finally, we sift through some of the evidence about the socioeconomic and residential assimilation of recent immigrant groups. Though the record is clearly mixed, we find evidence consistent with the view that assimilation is taking place, albeit unevenly

Rethinking assimilation theory for a new era of immigration.

L'A. etudie la representation des prejudices. Il evalue la perception de la menace que les groupes subordonnes ferraient peser sur les groupes dominants. Il estime que les conditions economiques et l'importance des groupes subordonnes par rapport aux groupes dominants expliquent ce type de perception. Il note a partir de donneees europeennes des disparites entre les 12 sur ce plan precis. Cette perception de la menace « ethnique » expliquerait le sentiment de prejudice. L'A. invite aux vues de ses analyses a revoir celles du passe

https://www.jstor.org/stable/pdfplus/2096296.pdf

Prejudice as a response to perceived group threat: population composition and anti-immigrant and racial prejudice in Europe

The objective of this study was to describe secular trends in the distribution of blood pressure and prevalence of hypertension in US adults and changes in rates of awareness, treatment, and control of hypertension. The study design comprised nationally representative cross-sectional surveys with both an in-person interview and a medical examination that included blood pressure measurement. Between 6530 and 13,645 adults, aged 18 through 74 years, were examined in each of four separate national surveys during 1960-1962, 1971-1974, 1976-1980, and 1988-1991. Protocols for blood pressure measurement varied significantly across the surveys and are presented in detail. Between the first (1971-1974) and second (1976-1980) National Health and Nutrition Examination Surveys (NHANES I and NHANES II, respectively), age-adjusted prevalence of hypertension at > or = 160/95 mm Hg remained stable at approximately 20%. In NHANES III (1988-1991), it was 14.2%. Age-adjusted prevalence at > or = 140/90 mm Hg peaked at 36.3% in NHANES I and declined to 20.4% in NHANES III. Age-specific prevalence rates have decreased for every age-sex-race subgroup except for black men aged 50 and older. Age-adjusted mean systolic pressures declined progressively from 131 mm Hg at the NHANES I examination to 119 mm Hg at the NHANES III examination. The mean systolic and diastolic pressures of every sex-race subgroup declined between NHANES II and III (3 to 6 mm Hg systolic, 6 to 9 mm Hg diastolic). During the interval between NHANES II and III, the threshold for defining hypertension was changed from 160/95 to 140/90 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population: Data From the Health Examination Surveys, 1960 to 1991

The notion that the demographic transition in the West has two distinct phases was originally suggested by Lesthaeghe and van de Kaa (1986) and elaborated by van de Kaa (1987). These authors proposed the terminology of a first and second demographic transition. The 1986 article posited that new living arrangements and cohabitation (premarital or postmarital) in particular were not solely the outcomes of changing socioeconomic conditions or rising female employment but equally the expression of secular and anti-authoritarian sentiments of better-educated men and women who held an egalitarian world view placed greater emphasis on Maslows (1954) "higher order needs" (i.e. self-actualization individualistic and expressive orientations need for recognition) and to use Ingleharts term (1970 1990) had stronger "postmaterialist" political orientations. Furthermore the second demographic transition would also be characterized by substantial postponement of both marriage and parenthood and by an increase in the share of births to unmarried couples. If fertility control during the first transition was a matter of avoiding births of higher parities and births at older ages in order to safeguard the opportunities of the children already born during the second it is a matter of postponing or eschewing parenthood altogether because of more pressing competing goals such as prolonging education achieving more stable income positions increased consumerism associated with self-expressive orientations finding a suitable companion and realizing a more fulfilled partnership keeping an open future and the like. (excerpt)

/pdf/the-second-demographic-transition-in-the-united-states-1bfra5w84o.pdf

The Second Demographic Transition in the United States: Exception or Textbook Example?

Investigators of social differentials in health outcomes commonly augment incomplete micro data by appending socioeconomic characteristics of residential areas (such as median income in a zip code) to proxy for individual characteristics. However, little empirical attention has been paid to how well this aggregate information serves as a proxy for the individual characteristics of interest. We build on recent work addressing the biases inherent in proxies and consider two health-related examples within a statistical framework that illuminate the nature and sources of biases. Data from the Panel Study of Income Dynamics and the National Maternal and Infant Health Survey are linked to census data. We assess the validity of using the aggregate census information as a proxy for individual information when estimating main effects, and when controlling for potential confounding between socioeconomic and sociodemographic factors in measures of general health status and infant mortality. We find a general, but not universal, tendency for aggregate proxies to exaggerate the effects of micro-level variables and to do more poorly than micro-level variables at controlling for confounding. The magnitude and direction of these biases, however, vary across samples. Our statistical framework and empirical findings suggest the difficulties in and limits to interpreting proxies derived from aggregate census data as if they were micro-level variables. The statistical framework we outline for our study of health outcomes should be generally applicable to other situations where researchers have merged aggregate data with micro data samples.

On the Validity of Using Census Geocode Characteristics to Proxy Individual Socioeconomic Characteristics

Investigators of social differentials in health outcomes commonly augment incomplete microdata by appending socioeconomic characteristics of residential areas (such as median income in a zip code) to proxy for individual characteristics. But little empirical attention has been paid to how well this aggregate information serves as a proxy for the individual characteristics of interest. We build on recent work addressing the biases inherent in proxies and consider two health-related examples within a statistical framework that illuminates the nature and sources of biases. Data from the Panel Study of Income Dynamics and the National Maternal and Infant Health Survey are linked to census data. We assess the validity of using the aggregate census information as a proxy for individual information when estimating main effects and when controlling for potential confounding between socioeconomic and sociodemographic factors in measures of general health status and infant mortality. We find a general, but...

/pdf/on-the-validity-of-using-census-geocode-characteristics-to-29aqjqmhed.pdf

Socioeconomic differentials separating whites and blacks have been shown to correlate positively with the percentage of blacks in a population. However, in multiracial or multiethnic populations, it is necessary to take into account the effects of the relative size of each minority present in nonnegligible numbers. In the research reported here, the relationship between socioeconomic inequality and the proportion of Mexican Americans and blacks in the population of metropolitan areas was decomposed through path-analytic techniques. Analysis of model incorporating the impact of the size of both minorities indicates that minority income levels are inversely related to minority size and that disparities between majority and minority income and occupation tend to grow as relative minority size increases. Mexican American occupational levels vary positively with the percentage of blacks, but black occupational status was foud th be virtually unrelated to the proportional representation of Mexican Americans in ...

https://www.jstor.org/stable/pdfplus/2777810.pdf

Inequality and the Relative Size of Minority Populations: A Comparative Analysis

This paper uses a new data source to investigate differences in occupational achievement among a large number of ethnic groups. The November, 1979 Current Population Survey is a unique source since it provides information on both the ancestry and nativity of a large national sample of respondents. These data are particularly valuable because they permit the identification of first-, secondand thirdor higher-generation individuals, thereby providing a clearer picture of the process of assimilation. We focus upon the achievements of men, age 20 to 64 classified simultaneously by nativity and ethnicity. Not surprisingly, there are notable differences in the occupational attainment of foreign-born men. Some of these differences are due to the diverse social and economic backgrounds of the different nationalities, but important differences in the rates of return to background characteristics are also evident. The assimilation perspective predicts that eventually ethnic background will no longer be an important determinant of socioeconomic achievement. By the third generation, we find this to be true for the most part, although important exceptions are discussed in this paper.

https://www.jstor.org/stable/pdfplus/2095507.pdf

Lisa Neidert

Papers

The Second Demographic Transition in the United States: Exception or Textbook Example?

On the Validity of Using Census Geocode Characteristics to Proxy Individual Socioeconomic Characteristics

On the Validity of Using Census Geocode Characteristics to Proxy Individual Socioeconomic Characteristics

Inequality and the Relative Size of Minority Populations: A Comparative Analysis

Assimilation in the United States: An Analysis of Ethnic and Generation Differences in Status and Achievement.